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Hundreds of B.C. doctors have been running afoul of professional and ethical standards by treating family members and then billing taxpayers for it.

An audit of doctors’ billings has revealed that 757 B.C. doctors were caught billing the taxpayer-funded Medical Services Plan a total of about $100,000 in the past four years for treating themselves or family members.

It’s an ethical, professional standards matter the College of Physicians and Surgeons of BC takes seriously. Last year, it sent letters of reprimand to about eight doctors who treated family members and then billed for it.

Providing medical care or prescribing a prescription to a family member may be convenient but it can also be problematic because of potential conflicts of interest and compromised medical care. For example, there may be difficulty taking or accessing a detailed medical history. Family members may conceal some information, or may not seek a second opinion for fear of offending the doctor in the family. Conducting sensitive examinations (of family members’ genitals, for example) is entirely inappropriate but in a standard doctor-patient relationship with true boundaries, such examinations may be necessary in order not to miss a diagnosis, according to College deputy registrar Dr. Ailve McNestry.

The College and the Canadian Medical Protective Association both state that sub-standard care can arise from situations when doctors provide medical care to family members.

While there may be exceptions — in emergencies, for example, or minor mishaps — doctors are still never supposed to bill the government for care provided to these family members: a spouse, son or daughter, stepson or stepdaughter, parent or step-parent, mother-in-law or father-in-law, grandparent, grandchild, brother or sister, and anyone living in the physician’s household.

McNestry said in an interview there are numerous pitfalls to interactions between doctors and patients with emotional and personal affiliations. For that reason, doctors should only treat a family member in an emergency, when the issue is minor, or when no other help is around. Doctors are then supposed to transfer care to an unrelated medical professional as soon as possible.

She said she recalls about eight cases last year when the College sent letters of reprimand to doctors who treated family or household members. While some cases were detected by an audit showing bills that matched the same names, other cases arose when disgruntled family members complained to the College.

In one case, a doctor prescribed medication to a family member who didn’t disclose he or she was taking a drug for a mental health problem; the combination of a narcotic with an anti-psychotic medication caused a severe reaction.

About half the time, said McNestry, doctors said they didn’t realize their medical office assistants had submitted bills for the services.

“Billing for these kinds of visits is like shining a flashlight on (the misconduct),” she said, referring to the fact that it makes it all that much easier to get caught doing something wrong and then facing the “humiliation” of a College investigation.

She said it’s possible that some doctors don’t realize they shouldn’t be treating family members and billing for it. And in some cultures, there may be expectations that family members who are doctors will provide medical service. That’s something that she hears about when she gives instructional sessions on professionalism and ethics to international medical graduates.

One of the more common occurrences is doctors who write prescriptions for family members for sedatives.

“It might only be 20 to 30 sleeping pill tablets to counteract jet lag but (it) is still inappropriate,” she said, noting that episodic prescriptions for family members are potentially disastrous, especially when doctors don’t know about all the prescriptions a family member is taking or even much about their medical history and status.

The issue is addressed in the current BC Medical Journal by Dr. Keith White, chairman of a Doctors of BC (formerly called the BC Medical Association) committee called Patterns of Practice.

“Billing for family members raises an ethical flag, which can lead to increased attention from the Billing Integrity Program — something most doctors would like to avoid. Billing a $30 visit for a family member is not worth the risk of being audited,” he said.

Doctors have been warned that if future audits find that billings for family care exceed more than $1,000, they will automatically be reported to the College for an investigation. The $1,000 threshold was chosen because it demonstrates that the billings are not one-off accidents, according to government spokesman Ryan Jabs.

Dr. Bill Cavers, the newly elected president of Doctors of BC, said he’s glad the issue is receiving attention because some doctors may be naive about the rules and therefore require education. In other cases, there are practical constraints which make it nearly impossible to avoid treating family members such as in very small communities with few doctors.

Cavers said he once had to put some stitches in his daughter’s bloodied hand. He didn’t bill for it “but she’s still complaining bitterly about the fact that I did that,” the Victoria doctor said.

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Doctors reprimanded for treating family members, then billing taxpayers

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